The PURE study is a large, epidemiological study of approximately 135,000 individuals aged 35–70 years in 18 countries with an average (median) follow-up of 7·4 years. The primary aim of the study was to assess the association of fats (total, saturated and unsaturated fats) and carbohydrate with total mortality and cardiovascular disease (CVD) events. The secondary aim was to examine associations between these nutrients and heart attacks, stroke, cardiovascular disease mortality and non-cardiovascular disease mortality.

Table 1 followed the grouping by region and it presented the characteristics of each region (Africa, China, Europe & North America, Middle East, south America, south Asia and southeast Asia) for physical, health and lifestyle characteristics: age; gender; urban location; blood pressure; waist to hip ratio; smoking; education; physical activity; and history of diabetes. As the primary aim of the study was to review fats and carbohydrate and events, Table 1 reported the percentage of energy that came from fats (total and individual), carbohydrate and protein for each region. This alone was fascinating. China had the highest percentage intake of carbohydrate at 67%. Europe and North America, as a region, was lowest at 52%.

The paper reported in the Discussion section: “A high carbohydrate diet is usually accompanied by a low fat intake.” “Usually” is probably not quite strong enough. As protein tends to be fairly constant in any diet, the macronutrients that vary are fat and carbohydrate. One goes up, the other concomitantly goes down. Interestingly, Table 1 confirmed the very small variation in protein intake in all diets. Five of the seven regions, covering 75% of study participants, had protein intakes of between 15-17.5% of energy intake. Africa and south Asia had lower protein intake: 13.4% and 11.6% respectively.

Other interesting findings from Table 1 were:

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